Peers Promoting Exercise Adoption and Maintenance among Cancer Survivors ABSTRACT Studies in research settings have demonstrated that exercise adoption among cancer survivors can improve their quality of life, mood and fatigue. Little has been done to translate these efforts into a community-setting. Such dissemination is essential to extend the reach of efficacious interventions to improve the recovery and well-being of cancer survivors. We have tested the effects of a 3-month telephone-based exercise program offered by community peer volunteers (specifically, Reach to Recovery [RTR] volunteers of the American Cancer Society [ACS]) to breast cancer survivors. This theory-based intervention was successfully delivered and was found to significantly increase exercise at 3 months (post-intervention) and at 6 months compared to a contact control condition. Intervention effects were significant but attenuated at 6 months. Exercise maintenance is important to sustain psychosocial benefits and may reduce risk for cancer recurrence. Maintenance of outcomes is also fundamental to informing the translation of evidence-based behavioral interventions into practice. Hence, prior to implementation in community-based organizations, we propose to enhance this intervention to support not only the adoption of exercise (3 months) but also its maintenance at 12 months by comparing three evidence-based maintenance interventions that can be implemented by community-based organizations. In this randomized controlled trial, after the 3-month telephone-based exercise program from RTR peer volunteers/coaches, we will compare three groups: 1) Reach Plus (exercise logs and feedback reports but no additional contact with coaches via phone or messages), 2) Reach Plus Phone (monthly counseling calls from coaches, exercise logs and feedback reports), and 3) Reach Plus Messages (monthly email/text messages, exercise logs and feedback reports). In sum, during Months 4-9, participants in the three groups will be asked to keep exercise logs and will be provided feedback reports; extended support will be offered via monthly telephone calls from the coaches (Reach Plus Phone) or email/text messages (Reach Plus Messages). We will enroll 150 patients and assess exercise (primary outcome), fatigue, QOL and mood at baseline, 3, 6, 9 and 12 months. We will also conduct cost-effectiveness analyses to inform dissemination efforts. If the proposed trial demonstrates positive effects, we will design a dissemination trial f a peer mentored approach for exercise adoption and maintenance among breast cancer survivors in a community setting. Partnering with cancer care organizations that offer peer mentoring can expand the reach (scale up) of efforts to enhance survivors' recovery.